Healthcare Provider Details

I. General information

NPI: 1154650653
Provider Name (Legal Business Name): HENRY COUNTY HEALTH & REHABILITATION OUTPATIENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 DOTHAN RD
ABBEVILLE AL
36310-2800
US

IV. Provider business mailing address

212 DOTHAN RD
ABBEVILLE AL
36310-2800
US

V. Phone/Fax

Practice location:
  • Phone: 334-585-2241
  • Fax: 334-585-5082
Mailing address:
  • Phone: 334-585-2241
  • Fax: 334-585-5082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0060
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2663
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH3384
License Number StateAL

VIII. Authorized Official

Name: MR. CHUCK HOUSTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 334-585-2241